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MONITORING WELL INSTALLATION REPORT <br /> Date: A)— /6 / CONSTRUCTION <br /> Premise Address: lo/1GIP7L Avt j��,�� Total Depth <br /> Screen Length (from)' (to) 0 <br /> Well No.: Filtei Pack (from) q6 (to)--_-T7S7— <br /> hentonite' (from) Z3 (to) Z-6 <br /> Inspector: 1/. r/(J64j i- Grout (from) 'Z b (to) / /3S(= <br /> m <br /> Permit No. �I�OO�fO"7(o Drilling rig me <br /> Auger O.D. !� I.D. <br /> �(6- Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: IL11-it- <br /> Driller:_ ,ei(_ jIflu 7-5 LLcasing <br /> height <br /> Consultant D FOIL 77/fi i�I/�G <br /> Geologis _QVT <br /> t H,J _5alwio%J PbA- OtQ0IAVO <br /> A30VE-4�R OUND <br /> a wF LETO N C_iS Z7Y-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. pend Suriaca <br /> Distance to sewer line grout <br /> Domestic well on site - (y/0 4 2-Z <br /> If yes, location and distance - y <br /> SAMPLING AM- 5 )k*"-+z( <br /> 5,1U 0 <br /> Holding Temperatpre <br /> Method /C S /jf��N►1� �� � - -= 7A's4 pack <br /> Screening Method__ 03C <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method ���U7Y.(�p �.jyV M_ gFEPJALS/DEVELOPMENT <br /> Contamination Notpd - (y/n ) <br /> Storage�L/ocatior/}_,�)✓OUIL I )tri CV) Casing type_ J�i'f. �0 /C <br /> eJJ <br /> tj / XT Blark ft. Screen_ <br /> Slot size <br /> GROUTING gtf L/j� Tj -4y-- V_ Bags cement . <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method <br /> Quantity Installed ► Discussed with geologist: / n ) <br /> EH 29 29 �' _�`7"K) 4- �n 6tL t4_�7 Type of method <br />